Child psychopathology

Child psychopathology is the manifestation of psychological disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity
disorder, and pervasive developmental disorder are examples of child psychopathology.
[1]
The full list of formal diagnostic codes and classification of mental health
disorders can be found in the DSM IV TR; this is the same manual which covers adult psychopathology, but it has certain diagnoses specific to children and
adolescents.
[2]
Counselors, social workers, psychologists and psychiatrists who work with mentally ill children are informed by research in developmental psychology,
developmental psychopathology, clinical child psychology, and family systems. The first section of the DSM IV-TR Disorders usually first diagnosed in infancy,
childhood or adolescence includes diagnoses from mental retardation to selective mutism. In addition, the DC 0-3 or Diagnostic Classification 0-3 is used to assess
mental health problems in infants. Selma Fraiberg was one pioneer in the field of Infant mental health.
Contents
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1 Etiology
2 Stress
3 Temperament
4 Neurology and Etiology
5 Agensis of the corpus collosum and etiology
6 Treatment
7 Future of Child Psychopathology
8 Theory and Research
9 References
10 External links
[edit]Etiology
The etiology of child psychopathology has many explanations which differ from case to case. Many psychopathological disorders in children involve genetic and
physiological mechanisms, though there are still many with out any physical grounds. It is absolutely imperative that multiple sources of data be gathered. Diagnosing
the psychopathology of children is daunting. It is influenced by development and contest, in addition to the traditional sources. Interviews with parents about school,
etc., are inadequate. Either reports from teachers or direct observation by the professional are critical. (author, Robert B. Bloom, Ph.D.)
[3]
The disorders with physical
or biological mechanisms are easier to diagnose in children and are often diagnosed earlier in childhood. However, there are some disorders, no matter the
mechanisms, that are not identified until adulthood. There is also reason to believe that there is co-morbidity of disorders, in that if one disorder is present, there is
often another.
[4]

[edit]Stress
Emotional stress or trauma in the parent-child relationship tends to be a cause of child psychopathology. First seen in infants, separation anxiety in root of parental-
child stress may lay the foundations for future disorders in children. There is a direct correlation between maternal stress and child stress that is factored in both
throughout adolescences development.
[5]
In a situation where the mother is absent, any primary caregiver to the child could be seen as the maternal relationship.
Essentially, the child would bond with the primary caregiver, exuding some personality traits of the caregiver.
In studies of child in two age groups of pregnancy to five years, and fifteen years and twenty years, Raposa and colleagues (2011) studied the impact of
psychopathology in the child-maternal relationship and how not only the mothers stress affected the child, but the childs stress affected the mother. Historically, it
was believed that mothers who suffered from post partum depression might be the reason their child suffers from mental disorders both earlier and later in
development. However this correlation was found to not only reflect maternal depression on child psychopathology, but also child psychopathology could reflect on
maternal depression.
Children with a predisposition to psychopathology may cause higher stress in the relationship with their mother, and mothers who suffer from psychopathology may
also cause higher stress in the relationship with their child. Child psychopathology creates stress in parenting which may increase the severity of the psychopathology
within the child.
[6]
Together, these factors push and pull the relationship thus causing higher levels of depression, ADHD, defiant disorder, learning disabilities, and
pervasive developmental disorder in both the mother and the child. The outline and summary of this study is found below: ""In looking at child-related stress, the
number of past child mental health diagnoses significantly predicted a higher number of acute stressors for mothers as well as more chronic stress in the mother-
child relationship at age 15. These increased levels of maternal stress and mother-child relationship stress at age 15 then predicted higher levels of maternal
depression when the youth were 20 years old.
Looking more closely at the data, the authors found that it was the chronic stress in the mother-child relationship and the child-related acute stressors that were the
linchpins between child psychopathology and maternal depression. The stress is what fueled the fires between mother and child mental health. Going one step
further, the researchers found that youth with a history of more than one diagnosis as well as youth that had externalizing disorders (e.g., conduct disorder) had the
highest number of child-related stressors and the highest levels of mother-child stress. Again, all of the findings held up when other potentially stressful variables,
such as economic worries and past maternal depression, were controlled for.
[7]

Additionally, siblings- both older and younger and of both genders, can be factored in to the etiology and development of child psychopathology. In a longitudinal
study of maternal depression and older male child depression and antisocial behaviors on younger siblings adolescent mental health outcome. The study factored
in ineffective parenting and sibling conflicts such as sibling rivalry. Younger female siblings were more directly affected by maternal depression and older brother
depression and anti social behaviors when the indirect effects were not place, in comparison to younger male siblings who showed no such comparison. However, if
an older brother were anti social, the younger child- female or male would exude higher anti- social behaviors. In the presence of a sibling conflict, anti social
behavior was more influential on younger male children than younger female children. Female children were more sensitive to pathological familial environments,
thus showing that in a high- stress environment with both maternal depression and older- male sibling depression and anti social behavior, there is a higher risk of
female children developing psychopathological disorders.
[8]
This was a small study, and more research needs to be done especially with older female children,
paternal relationships, maternal-paternal-child stress relationships, and/or caregiver-child stress relationships if the child is orphaned or not being raised by the
biological child to reach a conclusive child-parent stress model on the effects of familial and environmental pathology on the childs development.
[edit]Temperament
The child-parent stress and development is only one hypothesis for the etiology of child psychopathology. Other experts believe that childtemperament is a large
factor in the development of child psychopathology. High susceptibility to child psychopathology is marked by low levels of effortful control and high levels of
emotionality and neuroticism. Parental divorce is often a large factor in childhood depression and other psychopathological disorders.
[9]
That is not to say that divorce
will lead to psychopathological disorders, there are also other factors such as temperament, trauma, and other negative life events (e.g. death, sudden moving of
home, physical or sexual abuse), genetics, environment, and nurture that correlate to the onset of a disorder.
Found in The Role of Temperament in the Etiology of Child Psychopathology, a model for the etiology of child psychopathology by Vasey and Dadds (2001)
proposed that the four things that are important to the development of psychopathological disorders is: 1) biological factors: hormones, genetics, neurotransmitters
2) psychological: self-esteem, coping skills, cognitive issues 3) social factors: family rearing, negative learning experiences, and stress 4) childs temperament. Using an
array of neurological scans and exams, psychological assessment tests, family medical history, and observing the child in daily factors can help the physician find the
etiology of the psychopathological disorder to help release the child of the symptoms through therapy, medication use, social skills training, and life style changes.
[9]

Child psychopathology can cause separation anxiety from parents, attention deficit disorders in children, sleep disorders in children, aggression with both peers and
adults, night terrors, extreme anxiety, anti social behavior, depression symptoms, aloof attitude, sensitive emotions, and rebellious behavior that are not in line of
typical childhood development. Aggression is found to manifest in children before five years of age, and early stress and aggression in the parental-child relationship
correlates with the manifestation of aggression. Aggression in children causes problematic peer relationships, difficulty adjusting, and coping problems. Children who
fail to overcome acceptable ways of coping and emotion expression are put on tract for psychopathological disorders and violent and anti social behaviors into
adolescence and adulthood. There is a higher rate of substance abuse in these children with coping and aggression issues, and causes a cycle of emotional instability
and manifestation psychopathological disorders.
[edit]Neurology and Etiology
Borderline personality disorder (BPD) is one of many psychopathology disorders a child can suffer from. In the neurobiological scheme, borderline personality
disorder may have effects on the left amygdala. In a 2003 study of BPD patients versus control patients, when faced with expressions that were happy, sad, or fearful
BPD patients showed significantly more activation versus control patients. In neutral faces, BPD patients attributed negative qualities to these faces.
[10]
As stated by
Gabbard, an experimenter in this study: ""A hyperactive amygdala may be involved in the predisposition to be hyper vigilant and over reactive to relatively benign
emotional expressions. Misreading neutral faces is clearly related to transference mis-readings that occur in psychotherapy and the creation of bad object
experiences linked with projective identification.""
[10]

Also linked to BPD, is the presence of serotonin transporter (5-HTT) in a short allele demonstrated larger amygdala neuronal activity when presented with fearful
stimuli as in comparison to individuals with a long allele of 5-HTT. As found in the Dunedin longitudinal study a short allele of 5-HTT predisposes the person to have
hyperactivity in the amygdala in response to trauma, and thus moderated the impact of stressful life events leading to a higher risk of depression and suicidal
idealities. These same qualities were not observed in individuals with long alleles of 5-HTT. However, the environment the child is in can change in impact of this
gene, proving that correct treatment, intensive social support, and a healthy and nurturing environment can modify genetic vulnerability.
[10]

Possibly the most studied or documented of the child psychopathologies is Attention Deficient Hyperactivity Disorder (ADHD) which is marked with learning
disabilities, mood disorders, and/or aggression. Though believed to be over diagnosed, ADHD is highly comorbid for other disorders such as depression and obsessive
compulsive disorder. In studies of the prefrontal cortex in ADHD children, which is responsible for the regulation of behavior, cognition, and attention; and in the
dopamine system there has been identified a hidden genetic polymorphisms. More specific, the 7-repeat allele of the dopamine D4 receptor gene, responsible for
inhibited prefrontal cortex cognition and less efficient receptors, causes more externalized behaviors such as aggression since the child has trouble thinking through
seemingly ordinary and at level childhood tasks.
[11]

[edit]Agensis of the corpus collosum and etiology
Agensis of the corpus collosum (ACC) is used to determine the frequency of social and behavioral problems in children with a prevalence rate of about 2-3%. ACC is
described as a defect in the brain where the 200 million axons that make the corpus collosum are either completely absent, or partially gone. In many cases, the
anterior commissure is still present to allow for the passing of information from one cerebral hemisphere to the other. The children are of normal intelligence level.
For younger children, ages two to five, agensis of the corpus collosum causes problems in sleep. Sleep is critical for development in children, and lack of sleep can set
the grounds for a manifestation of psychopathological disorders.
[12]
In children ages six to eleven, ACC showed manifestation in problems with social function,
thought, attention, and somatic grievances. In comparison of children with autism, children with ACC showed less impairment on almost all scales such as anxiety and
depression, attention, abnormal thoughts, and social function versus autistic children. However, a small percentage of children with ACC showed traits that may lead
to the diagnosis of autism in the areas of social communications and social interactions but do not show the same symptoms of autism in the repetitive and restricted
behaviors category.
[13]
The difficulties from ACC may lead to the etiology of child psychopathological disorders, such as depression or ADHD and manifest many
autistic-like disorders that can cause future psychological disorders in later adolescence. The etiology of child psychopathology is a multi-factor path. A slew of factors
must be taken into account before diagnosis of a disorder.
The childs genetics, environment, temperament, past medical history, family medical history, prevalence of symptoms and neuro-anatomical structures are all
factors that should be considered when diagnosing a child with a psychopathological disorder.
[13]
Thousands of children each year are misdiagnosed and put on the
wrong treatment, which may result in the manifestation of other disorders the child would have not have gotten else wise. There are hundreds of causes of
psychopathological disorders, and each one manifests at different ages and stages in child development and can come out due to trauma and stress. Some disorders
may disappear and reappear in the presence of a trauma, depression, or stress similar to the one that brought the disorder out in the child in the beginning.
[edit]Treatment
It is estimated that 5% of children under the age of eight suffer from a psychopathology disorder. Girls more frequently manifested disorders than boys in similar
situations. By age sixteen about thirty percent of children will have fit the criteria for at least one psychopathology disorder. Only a small number of these children
receive treatment for their disorder. Anxiety and depression disorders in children- whether noted or unnoted, are found to be a precursor for similar episodes in
adulthood. Usually a large stressor similar to the one the person experienced in childhood brings out the anxiety or depression in adulthood.
Multifinality refers to the idea that two children can react totally different to same stressful event and display divergent types of problem behavior.
Psychopathological disorders are extremely situational- having to take into account the child, the genetics, the environment, the stressor, and many other factors to
tailor the best type of treatment to relieve the child of the psychopathology symptoms.
Many child psychopathology disorders are treated with control medications prescribed by a pediatrician or psychiatrist. After extensive evaluation of the child
through school, psychologists, and physicians a medication can be prescribed. The medicines can take as little as a day to achieve effectiveness or as long as four to
eight weeks. At times, a child goes through several trials of medicines to find the best fit, as many cause uncomfortable and undesired side effects- such as dry mouth
or suicidal thoughts. There are many classes of drugs a physician can choose from and they are: psychostimulants, beta blockers, atypical anti
psychotics, lithium, alpha-2 agonists, traditional antipsychotics, SSRIs, andanticonvulsant mood- stabilizers. Given the multifinality of psychopathological disorders,
two children may be on the same medication for two completely different disorders, or have the same disorder and be taking two completely different medications.
ADHD is the most successfully treated disorder of child psychopathology, and the medications used have a high- abuse rate especially among college-aged students.
Psycho stimulants such as Ritalin, amphetamine- related stimulant drugs: e.g., Adderall, and antidepressants such asWellbutrin have been successfully used to treat
ADHD with a 78% success rate. Many of these drug treatment options are paired with behavioral treatment such as therapy or social skills lessons.
Lithium has shown to be extremely effective in treating ADHD and bipolar disorder. Lithium treats both mania and depression and helps prevent relapse. The
mechanism of lithium include the inhibition of GSK-3, it is a glutamate antagonism at NMDA receptors that together make lithium a neuroprotective medicine. The
drug relieves bipolar symptoms, aggressiveness and irritability. Lithium has many, many side effects and requires weekly blood tests to tests for toxicity of the drug.
Medications that act on cell membrane ion channels, are GABA inhibitory neurotransmission, and also inhibit excitatory glutamate transmission have shown to be
extremely effective in treating an array of child psychopathological disorders. Pharmaceutical companies are in the process of creating new drugs and improving
those on the market to help avoid negative and possibly life altering short term and long term side effects, making the drug more safe to use in younger children and
over long periods of time during adolescent development.
[edit]Future of Child Psychopathology
The future of child psychopathology- etiology and treatment has a two-way path. While many professionals agree that many children who suffer from a disorder do
not receive proper treatment, at the rate of 5-15% that receive treatment leaving many children in the dark. In the same boat are the physicians who also say that not
only do more of these disorders need to be recognized in children and treated properly, but also even those children who show some qualifying symptoms of a
disorder but not to the degree of diagnosis should also receive treatment and therapy to avoid the manifestation of the disorder. By helping children even with slight
degrees of a psychopathological disorder, children show vast improvements in their relationships with peers, family, and teachers and also improvements in school,
mental health, and personal development.
[14]
Many physicians believe the best prevention and help starts in the home and the school of the child, before physicians
and psychologists are contacted.
So while there is more awareness of child psychopathological disorders and more research to prevent and effectively treat these disorders to maintain healthy
emotional health in children, there is also a negative factor in that parents, schools, and psychologists may be more sensitive and therefore over-diagnose children
with these disorders. Then pharmaceutical companies and therapists have to tailor these influxes and backtrack on wrongly diagnosed children to solve the problem
correctly. Psychologists and marking companies of the medicines used to treat psychopathological disorders need to be cautious of making disorders, such as child
hood ADHD, glamorous ones to prevent parents from trying to label their child for any out cry or flash of aggression the child shows.
Child psychopathology is a real thing that thousands of children suffer from. While hundreds of children are diagnosed with a new disorder daily, researchers are
developing new strategies to beat these disorders in children to allow all children the right to a happy and healthy childhood. With further education on the
symptoms and implications of child psychopathology, psychologists and physicians will improve their accuracy in diagnosing children- giving the right diagnosis and
discovering the most helpful treatment and therapies for children.
[edit]Theory and Research
The current trend in the U.S. is to understand child psychopathology from a systems based perspective called developmental psychopathology. Recent emphasis has
also been on understanding psychological disorders from a relational perspective with attention also given to neurobiology. Practitioners who follow attachment
theory believe that early attachment experiences of children can promote adaptive strategies or lay the groundwork for maladaptive ways of coping which can later
lead to mental health disorders.
[15][16]

Research and clinical work on child psychopathology tends to fall under several main areas: etiology, epidemiology, diagnosis, assessment, and treatment.